Group analysis: values with which to explore values?

"Values-based practice" (VBP) is an interesting development in mental health practice, emerging as a corrective to the inordinate influence of "evidence-based practice" (NIMHE, 2004; Woodbridge & Fulford, 2004). VBP supports the key principles of: (a) recognition—that values are vitally important factors that are implicated in all areas of mental health practice; (b) awareness-raising—that unspoken, underlying values continually influence our practice and judgments, as clinicians and clients; and (c) the cultivation of respect—it is on the basis of this recognition and practice-reflection that true "anti-discriminatory" practice can be founded on respect for the diversity of values that exist in contemporary society. The importance of valuing diversity succeeds, or so it would seem, the decline of more monolithic traditions or singular sources of authority, being part of a process that Berger (1969) refers to as the "pluralisation of life-worlds". To the authors of VBP, such sensitivity and development is an essential component in the ongoing training and cultivation of a capable work-force, indeed citizenry. Woodbridge and Fulford (2004) offer a political analogy: "VBP as being rather like a political democracy" (p. 17), as opposed to authoritarian or totalitarian regimes. But far from being "anything goes", VBP argues that it is more important to promote a "right approach", to facilitate a culture in order to access and understand the values of other people—and potential conflicts between values—than to impose "right values". VBP is a useful way of helping practitioners and policy-makers improve awareness of the implied value assumptions that govern their practice and language.

In his famous psychoanalytic paper, Rey (1988) posed the question, "What is it that the patient brings to analysis?" Rey's answer is that they bring damaged internal objects with the expectation of repair; given the lateral perspective of group analysis, it is important to insist that clients also "bring" the wider worlds which they inhabit, and not only damaged features, including values, sustaining beliefs, backgrounds ideals, and horizons. Values surround us like the air we breathe and, hence, from a certain point of view, group analysis could be thought of as a particular form of values-based practice, or at least, as a medium in which this can occur.

Clinical reflections: a synthesis

Prakesh and Andrea were torn between a deferential or submissive attitude ("Tell me what to do", "You are the expert", "You others are more interesting/clever than me", etc.) and the desire for greater power and equality in relationships. Their conservative positions predominated for a long time, which the group accepted in some ways but did not reinforce. I have suggested that democratic processes and values were an integral part of what helped Prakesh and Andrea to develop autonomy and thus to see themselves differently. In Grace's group, I proposed that her struggles as an older adult, could partly be thought of in terms of a struggle between competing internal values (e.g., "I like to care for others" versus "I want more independence") and that there were conflictual values between group members, some of which had a generational dimension. Thus, Grace was influenced by regulative ideals concerning caring, loyalty, and serving family (in the past, actual, in the present, internal), whilst her group contemporaries were influenced by other regulative ideals, such as the priority of self-expression and independence from family. In many senses we are all multicultural^[1] and "more free to decide" (Laclau & Mouffe, 1985) as we move through life and manage differing contexts (including the context of the therapy group). In these examples, and is particularly interesting in terms of value-change, Prakesh had moved from one culture to another, Andrea felt like a fish out of water in a supposedly "educated" group of people (this was partly her perception and based on inferiority feelings), and Grace had lived through many sea-changes in the social world over more than sixty years; each was attempting to forge a satisfactory resolution or reconciliation in the contemporary world and in each instance, the spirit of group analysis was intended to promote useful group and democratising processes rather than to impose "answers". Finally, in the case of the relatives group, the host service grew to recognise, and so to better value, the "carer identity" alongside that of immediate service users. This could only happen as part of a wider shift in society, enabling new constituencies—such as carers—to find an assertive voice.

• [1] Tully's (1995) analysis of the politics of cultural difference extends the meaning of the cultural from ethnicity alone and argues that we all "cross cultures" in different ways; he deconstructs the idea of cultures as homogeneous, colliding entities.